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09120117 (2) CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 1170 CRESTLINE DR CONTRACTOR:AAA FURNACE&AIR PERMIT NO:09120117 CONDITIONING OWNER'S NAME: HAO JU LEE 1712 STONE AVE DATE ISSUED: 12/18/2009 ER'S PHONE: 4086211698 SAN JOSE,CA 95125 PHONE NO:(408)293-4717 ❑ (('�� LICENSED CONTRA-C-T�O//R��'GS DECLARATION BUILDING PERMIT INFO: BLDG� ELECT� PLUMB� License Class°- L' Lic.# ! l0 8 r `'-/ MECH RESIDENTIAL COMMERCIAL Contractor 4 d 40-4- Date Z— I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:REMOVE EXISTING FURNACE&INSTAL NEW FURNACE IN (commencing with Section 7000)of Division 3 of the Business&Professions SAME LOCATION Code and that my license is in full force and effect. I hereby affirm under penalty of perjury one of the following two declarations: I have and will maintain a certificate of consent to self-insure for Worker's Compensation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. I have and will maintain Worker's Compensation Insurance,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this Sq.Ft Floor Area: Valuation:$2870 permit is issued. APPLICANT CERTIFICATION APN Number:36224043.00 Occupancy Type: I certify that I have read this application and state that the above information is correct.I agree to comply with all city and county ordinances and state laws relating to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save PERMIT EXPIRES IF WORK IS NOT STARTED indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which ma cr,e against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR granting of this perm. d'u nally,the applicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION. with all nom—nowt s rue r ations per the Cupertino Municipal Code,Section 9.18. Signature Date 2 Issued by •"' ?�_ Date:� �p1-�x' ❑ OWNER-BUILDER DECLARATION RE-ROOFS: 1 hereby affirm that I am exempt from the Contractor's License Law for one of All roofs shall be inspected prior to any roofing material being installed.If a roof is the following two reasons: installed without first obtaining an inspection,I agree to remove all new materials for 1,as owner of the property,or my employees with wages as their sole compensation, inspection. will do the work,and the structure is not intended or offered for sale(Sec.7044, Business&Professions Code) Signature of Applicant: Date: I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER I hereby affirm under penalty of perjury one of the following three declarations: HAZARDOUS MATERIALS DISCLOSURE I have and will maintain a Certificate of Consent to self-insure for Worker's Compensation,as provided for by Section 3700 of the Labor Code,for the I have read the hazardous materials requirements under Chapter 6.95 of the performance of the work for which this permit is issued. California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain I have and will maintain Worker's Compensation Insurance,as provided for by compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& Safety Code,Section 25532(a)should I store or handle hazardous material. Section 3700 of the Labor Code,for the performance of the work for which this Additionally,should I use equ' ent or devices which emit hazardous air permit is issued. contaminants as define y Bay Area Air Quality Management District 1 will I certify that in the performance of the work for which this permit is issued,I shall maintain compliance it Cupertino Municipal Code,Chapter 9.12 and the not employ any person in any manner so as to become subject to the Worker's �, ealth Safety Co , ons 25505,25533,and 25534. Compensation laws of California. If,after making this certificate of exemption,I become subject to the Worker's Compensation provisions of the Labor Code,I must O ne or utho gent: Z �� 0 forthwith comply with such provisions or this permit shall be deemed revoked. ' ' Date: 5 CONSTRUCTION LENDING AGENCY APPLICANT CERTIFICATION I hereby a I certify that I have read this application and state that the above information is affirm that there is a constriction lending agency for the performance of work's correct.1 agree to comply with all city and county ordinances and state laws relating for which this permit is issued(Sec.3097,Civ C.) to building construction,and hereby authorize representatives of this city to enter Lender's Name ur,- the above mentioned property for inspection purposes.(We)agree to save i iify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address co—,and expenses which may accrue against said City in consequence of the granting of this permit.Additionally,the applicant understands and will comply ARCHITECT'S DECLARATION with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. 1 understand my plans shall be used as public records. Signature Date Licensed Professional 09Q0 � � � CITY OF CUPERTINO FURNACE/AC CUPEkTINO PERMIT APPLICATION FORM APN # i � � � 1�1 Date: Building Address: I )d C r es*1-og, beiv<; Owner's Name: Phone#: RAO Ju 1-e e- ZU � - Contractor: -P a nJb 14 \j A C Phone#: W fr - 3 4 Fax#: '/O�— --(v 'ice Contractor License#: -7 (,�, Sr Cupertino Business License#: Contact: -"1 a rl /a w 'Z-le 2 Phone#: VO T' `13 -5," 7/ 7 Fax #: S- 293 - 6-,7 Building Permit Info: Elect M--1— Plumb Mech 0' Residential Commercial Job Description: -Qe rno oe ic vc,'Sf,ny F=-u--^x-,cL ct r►d �^'s'``ri/ N /N Sq rvie- l C)C g7Fiory For Residential Installations: Attic ❑ 1St floor D� 2nd floor ❑ Adhere to minimum setback requirement ❑ For Commercial Installations: Replacement same weight ❑ Additional weight (structural calcs) ❑ Structural Calculations required for new installation ❑ New installation Planning Approval Required ❑ Cost of Project:2g8-)a00 Type of Construction (Usage Class): l/r) Strapped On Platform Bonled New Location Replacement Project Size: Express E Standard ❑ Lar e ❑ Major❑ Valuation: 3 4-$-70, ©O Green Building: Please complete relevant portion of the Green Building Checklist & attach it to the application or if applicable, include in plan set & the sheet index. - _ Revised 01/07/09 CITY OF C UPERTINO FURNACE/AC CUPEkTINO FEE SCHEDULE Quantity Fee ID Fee Description Fee Permit Type Group FURNACE FURN/AC 1 MCRAA Commercial-Rep,iir/Alterati on/Add to M ea heating appli ai ice,refrigeration unit, cooling unit,abso ption unit,or ea heating,cooling,a-)sorption or evaporative cooli zg system,incl installation of controls regulated by this code. 1 MCREPALT Commercial for tale repair of alt/add to M ea heating appliance,refrigeration unit,cooling unit,VAV boxes, absorption unit or ea heathing, cooling absorption,or evaporative cooling sys, incl install of controls regulated by this code. 1MCSUSHTR Commercial Instz.11/Relocate ea M suspended heater recessed wall htr, or floor mounted unit heater. 1PGASCOM Commerical for ea gas piping System P 1-4 outlets 1BPGAS For each gas pipi:ig system of 5 or P more per outlet. 1 MCAPPVNT Commercial fort ze install/relocate/ or M replacement of ez. appliance vent installed & not incl in an appliance permit. 1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT TYPES 1 BSEISMICO Commercial Seismic B 1MRRAA Residential Repair/Alteration/Add to M ea heating appliance,refrigeration unit, cooling unit,absoption unit,or ea heating,cooling,a sorption or evaporative cooli 1g system,incl installation of controls regulated by this code. 1 MRSUSHTR Residential Instal[/Relocate ea M suspended heater,recessed wall htr, or floor mounted umt heater. r : CITY OF 41"'UPERTINO FURNACE/AC CUPEk iNO FEE SCHEDULE Quantity Fee ID Fee Description Fee Permit Type Group AIR FURN/AC CONDITIONING 1 BCAIRHAN Commercial A/C Units <= l Ok CFM B 1 MCRAA Commercial Mech Repair/alt/add M 1 BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT TYPES 1BSEISMICO Seismic Commercial B 1 PGASCOM Commerical for ea gas piping System P 1-4 outlets 1 PGASRES Residential for oa gas piping system P of 1-4 Outlets 1BPGAS For each gas piping system of 5 or P more per outlet. Comm/Resid 1 BREMAIRHAN Residential A/C units <= l Ok CFM B 1 MRRAA Residential Mec;h Repair/alt/add M 1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT TYPES 1BSEISMICR Seismic Residential B 1 EPERMITFEE Electric Permit E I 1MPERMITFEE Mechanical Per nit M / 1 PPERMITFEE Plumbing Perm.t P 1 TRAVDOC Travel Docume ztation B 1 BUSLIC Business Licem e B Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 ;,UPEkTINO Building Department JOB ADDRESS: I C r�.S f UfW- D2_ PERMIT # Z0l C� OWNER'S NAME: t4 pj d TLA La� PHONE #408'. )-10? GENERAL CONTRACTOR: F}c' /�C. FAX # aE-- -,qcj 7 I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information: SUBCONTRACTOR BUSI14ESS NAME BUSINESS LICENSE # Cabinets &Millwork Cement Finishing Electrical Excavation Fencing Flooring: Carpeting Linoleum/ Wood Glass/ Glazing Heating Insulation Landscaping Lathing Masonry Ornamental Sheet Metal Painting/ Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/Contr r Signature Date